ENDING TB and MDR-TB The WHO END-TB Strategy Dr Mario RAVIGLIONE Director Joint GDI/GLI Partners Forum WHO Geneva, 27 April 2015
This talk will deal with TB Burden Progress, Challenges Way Forward
Who carries the burden of tuberculosis? mostly, the most vulnerable TB spreads in poor, crowded & poorly ventilated settings 510,000 women and 80,000 children die of TB each year; 10 million TB orphans Migrants, prisoners, minorities, refugees face risks, discrimination & barriers to care TB linked to HIV infection, malnutrition, alcohol, drug and tobacco use, diabetes
TB is a top infectious disease killer Infectious diseases Global Deaths (N= 9.491 M) 3500 3000 2500 2000 1500 1000 500 0 In blue: TB/HIV deaths
The Global Burden of TB - 2013 550,000 in children 3.3 m in women 510,000 in women 80,000 in children Source: WHO Global TB Report 2014
Estimated TB incidence rates, 2013 E. Mediterranean 8% Europe 4% Americas 3% South-East Asia 38% Africa 29% 34% in India + China 23% in India Western Pacific 18%
Addressing MDR-TB as a crisis Percentage of new TB cases with MDR-TB Highest % in the former USSR countries Ref: Global TB Control Report 2014 India, China, Russia, Pakistan and Ukraine have 60% of all MDR-TB cases
Number of MDR-TB cases estimated to occur among notified pulmonary TB cases, 2013
TB cases and deaths in slow decline, 1990-2013 All TB deaths Incidence peaked at 9.5 million in 2004 9 million in 2013 Total mortality peaked in 2002 at 1.7 million 1.5 million in 2013
Global progress on impact - 2013 37 million lives saved since 2000 Reduction in TB mortality rate 45% since 1990 Incidence falling slowly (1.5%/yr): 2015 MDG on track 4.8 million lives saved since 2005 through TB/HIV collaborative activities 86% cure rate 61 million patients cured, 1995-2013
Challenges: Priorities for action 2015 5 PRIORITIES FOR ACTION Reaching the missed cases (3 million not in the system) Address MDR-TB as crisis Accelerate response to TB/HIV Increase financing to close resource gaps Intensify research and ensure rapid uptake of innovations
67 th World Health Assembly, Geneva, May 2014 End TB Strategy 2016 2035
The End TB Strategy: Snapshot
Vision, goal, targets, milestones Vision: A world free of TB Zero TB deaths, Zero TB disease, and Zero TB suffering Goal: End the Global TB epidemic
The End TB Strategy: 3 pillars and 4 Principles
The End TB Strategy - Components 1. INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION A. Early diagnosis of tuberculosis including universal drug-susceptibility testing, and systematic screening of contacts and high-risk groups B. Treatment of all people with tuberculosis including drug-resistant tuberculosis, and patient support C. Collaborative tuberculosis/hiv activities, and management of co-morbidities D. Preventive treatment of persons at high risk, and vaccination against tuberculosis 2. BOLD POLICIES AND SUPPORTIVE SYSTEMS A. Political commitment with adequate resources for tuberculosis care and prevention B. Engagement of communities, civil society organizations, and public and private care providers C. Universal health coverage policy, and regulatory frameworks for case notification, vital registration, quality and rational use of medicines, and infection control D. Social protection, poverty alleviation and actions on other determinants of tuberculosis 3. INTENSIFIED RESEARCH AND INNOVATION A. Discovery, development and rapid uptake of new tools, interventions and strategies B. Research to optimize implementation and impact, and promote innovations
The End TB Strategy - Components 1. INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION A. Early diagnosis of tuberculosis including universal drug-susceptibility testing, and systematic screening of contacts and high-risk groups B. Treatment of all people with tuberculosis including drug-resistant tuberculosis, and patient support C. Collaborative tuberculosis/hiv activities, and management of co-morbidities D. Preventive treatment of persons at high risk, and vaccination against tuberculosis 2. BOLD POLICIES AND SUPPORTIVE SYSTEMS A. Political commitment with adequate resources for tuberculosis care and prevention B. Engagement of communities, civil society organizations, and public and private care providers C. Universal health coverage policy, and regulatory frameworks for case notification, vital registration, quality and rational use of medicines, and infection control D. Social protection, poverty alleviation and actions on other determinants of tuberculosis 3. INTENSIFIED RESEARCH AND INNOVATION A. Discovery, development and rapid uptake of new tools, interventions and strategies B. Research to optimize implementation and impact, and promote innovations
Five priority actions to address the global MDR-TB crisis ACTIONS NEEDED ON ALL FRONTS FROM PREVENTION TO CURE
Desired decline in global TB incidence rates to reach the 2035 targets
Investing in TB control is highly beneficial Development - The economics of optimism, Jan 24th 2015 - The debate heats up about what goals the world should set itself for 2030
Many thanks to all!